Provider Demographics
NPI:1912398173
Name:WISE DENTAL CARE
Entity type:Organization
Organization Name:WISE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-985-1263
Mailing Address - Street 1:7373 W. JEFFERSON AVE
Mailing Address - Street 2:#305
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235
Mailing Address - Country:US
Mailing Address - Phone:303-985-1263
Mailing Address - Fax:303-985-1659
Practice Address - Street 1:7373 W JEFFERSON AVE
Practice Address - Street 2:#305
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2038
Practice Address - Country:US
Practice Address - Phone:303-985-1263
Practice Address - Fax:303-985-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty